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Outcomes of Refractive Surgery Consultations at an Academic Center: Characteristics Associated with Proceeding (or Not Proceeding) with Surgery.

ABSTRACT: Objective:Refractive surgery volume has not rebounded despite economic recovery and literature describing safety, efficacy, and high patient satisfaction. We sought to examine characteristics of consultation seekers and status after consultation. Methods:Charts of patients seeking refractive surgery at Johns Hopkins University from 2013 through 2016 were retrospectively reviewed for age, gender, refractive characteristics, and outcome: surgery (photorefractive keratectomy, laser in-situ keratomileusis, implantable collamer lens, or refractive lens exchange); no surgery-"lost candidate" (good candidates who were lost after consultation); noncandidates based on technological limitations or contraindications; or no surgery-possessing expectations that surgery would not meet. Associations between characteristics and status after consultation were examined. Results:Twenty percent (142/712) of all patients were "lost candidates"; 57% (408/712) completed surgery. More women (56% or 401/712) sought consultation, but a greater percentage (63% or 195/311) of men completed surgery than women did (53% or 213/401) (p=0.02). Of consultation seekers, 60% were low myopes, 29% were high myopes (>6 diopters of myopic spherical equivalent), and 11% were hyperopes. Surgical patients' mean age was 34.2?±?10.2 (standard deviation) years; for each additional year of age, patients were less likely to have surgery (p < 0.001). Hyperopes were ?3 times more likely than myopes to have expectations not met by surgery or to be noncandidates than to have surgery (p < 0.005). Conclusions:Most patients seeking refractive surgery had 6 diopters or less of myopia. About 20% of patients were lost after consultation; better counseling and follow-up of candidates may be warranted. Expectations and technology limit eligibility for many, especially hyperopes. Low surgery volume may affect training of future refractive surgeons.

SUBMITTER: Kuo IC

PROVIDER: S-EPMC7152937 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Outcomes of Refractive Surgery Consultations at an Academic Center: Characteristics Associated with Proceeding (or Not Proceeding) with Surgery.

Kuo Irene C IC Lee Benjamin B Wang Jiangxia J

Journal of ophthalmology 20200330

<h4>Objective</h4>Refractive surgery volume has not rebounded despite economic recovery and literature describing safety, efficacy, and high patient satisfaction. We sought to examine characteristics of consultation seekers and status after consultation.<h4>Methods</h4>Charts of patients seeking refractive surgery at Johns Hopkins University from 2013 through 2016 were retrospectively reviewed for age, gender, refractive characteristics, and outcome: surgery (photorefractive keratectomy, laser i ...[more]

PMID: 32318279

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Project description:ImportanceApproximately 2 million cataract operations are performed annually in the US, and patterns of cataract surgery delivery are changing to meet the increasing demand. Therefore, a comparative analysis of visual acuity outcomes after immediate sequential bilateral cataract surgery (ISBCS) vs delayed sequential bilateral cataract surgery (DSBCS) is important for informing future best practices.ObjectiveTo compare refractive outcomes of patients who underwent ISBCS, short-interval (1-14 days between operations) DSBCS (DSBCS-14), and long-interval (15-90 days) DSBCS (DSBCS-90) procedures.Design, setting, and participantsThis retrospective cohort study used population-based data from the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry. A total of 1 824 196 IRIS Registry participants with bilateral visual acuity measurements who underwent bilateral cataract surgery were assessed.ExposuresParticipants were divided into 3 groups (DSBCS-90, DSBCS-14, and ISBCS groups) based on the timing of the second eye surgery. Univariable and multivariable linear regression models were used to analyze the refractive outcomes of the first and second surgery eye.Main outcomes and measuresMean postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) after cataract surgery.ResultsThis study analyzed data from 1 824 196 patients undergoing bilateral cataract surgery (mean [SD] age for those <87 years, 70.03 [7.77]; 684 916 [37.5%] male). Compared with the DSBCS-90 group, after age, self-reported race, insurance status, history of age-related macular degeneration, diabetic retinopathy, and glaucoma were controlled for, the UCVA of the first surgical eye was higher by 0.41 (95% CI, 0.36-0.45; P < .001) letters, and the BCVA was higher by 0.89 (95% CI, 0.86-0.92; P < .001) letters in the DSBCS-14 group, whereas in the ISBCS group, the UCVA was lower by 2.79 (95% CI, -2.95 to -2.63; P < .001) letters and the BCVA by 1.64 (95% CI, -1.74 to -1.53; P < .001) letters. Similarly, compared with the DSBCS-90 group for the second eye, in the DSBCS-14 group, the UCVA was higher by 0.79 (95% CI, 0.74-0.83; P < .001) letters and the BCVA by 0.48 (95% CI, 0.45-0.51; P < .001) letters, whereas in the ISBCS group, the UCVA was lower by -1.67 (95% CI, -1.83 to -1.51; P < .001) letters and the BCVA by -1.88 (95% CI, -1.98 to -1.78; P < .001) letters.Conclusions and relevanceThe results of this cohort study of patients in the IRIS Registry suggest that compared with DSBCS-14 or DSBCS-90, ISBCS is associated with worse visual outcomes, which may or may not be clinically relevant, depending on patients' additional risk factors. Nonrandom surgery group assignment, confounding factors, and large sample size could account for the small but statistically significant differences noted. Further studies are warranted to determine whether these factors should be considered clinically relevant when counseling patients before cataract surgery.

Project description:BackgroundThe debate of whether to centralize hepato-pancreato-biliary surgery has been ongoing. The principal objective was to compare outcomes of a community pancreatic surgical program with those of high-volume academic centers.MethodsThe current pancreatic surgical study occurred in an environment where (1) a certified abdominal transplant surgeon performed all surgeries; (2) complementary quality enhancement programs had been developed; (3) the hospital's trauma center had been verified; and (4) the hospital's surgical training had been accredited. Pancreatic surgical outcomes at high-volume academic centers were obtained through PubMed literature searches. Articles were selected if they described diverse surgical procedures. Two-tailed Fisher exact and mid-P tests were used to perform 2 × 2 contingency analyses.ResultsThe study patients consisted of 64 consecutive pancreatic surgical patients. The study patients had a similar pancreaticoduodenectomy proportion (59.4%) when compared to literature patients (66.8%; P = 0.227). The study patients also had a similar distal pancreatectomy proportion (25.0%) when compared to literature patients (31.9%; P = 0.276). The study patients had a significantly higher American Society of Anesthesiologists physical status ≥ 3 proportion (100%) than literature patients (28.1%; P < 0.001). The 90-day study mortality proportion (0%) was similar to the literature proportion (2.3%; P = 0.397). The study postoperative pancreatic fistula proportion was lower (3.2%), when compared to the literature proportion (18.4%; P < 0.001; risk ratio = 5.8). The study patients had a lower reoperation proportion (3.1%) than the literature proportion (8.7%; mid-P = 0.051; risk ratio = 2.8). The study patients had a lower surgical site infection proportion (3.1%) than those in the literature (21.1%; P < 0.001; risk ratio = 6.8). The study patients had equivalent delayed gastric emptying (15.6%) when compared to literature patients (10.6%; P = 0.216). The study patients had decreased Clavien-Dindo grades III-IV complications (10.9%) compared to the literature patients (21.8%; mid-P = 0.018). Lastly, the study patients had a similar readmission proportion (20.3%) compared to literature patients (18.4%; P = 0.732).ConclusionDespite pancreatic surgical patients having greater preoperative medical comorbidities, the current community study outcomes were comparable to or better than high-volume academic center results.

Project description:BackgroundAccumulating evidence suggests that refractive stabilization occurs rapidly following small incision cataract surgery. Nonetheless, many guidelines still suggest waiting four to 6 weeks before prescribing corrective lenses. This study was undertaken to supplement the existing literature regarding refractive stabilization, and evaluate multiple contributing factors that could dissuade clinicians from confidently correcting refractive error in the early post-operative course following routine cataract surgeries.MethodsAdult patients undergoing phacoemulsification cataract surgery with uncomplicated surgeries and post-surgical courses at the Calgary Ophthalmology Centre (Calgary, Alberta, Canada) were included in this prospective observational case series. Exclusion criteria included known corneal dystrophies, infectious keratitis, complicated surgery or toric/multifocal IOLs. Data was collected at weekly intervals for a total of 6 weeks. Collected data included autorefraction, visual acuity, corneal pachymetry, and effective lens position.ResultsOne hundred six eyes of 104 patients were included in this study. Post-operative sphere, cylinder and spherical equivalent were not significantly different at any post-operative week compared with week six, and 80-86% of patients were within 0.5D of last follow-up spherical equivalent at any week. The secondary outcomes of central corneal thickness, effective lens position and visual acuity did, however, exhibit significant differences between early post-operative weeks and last follow-up values.ConclusionsThese data suggest that refractive error can be effectively measured and corrected as early as one-week post-operatively in the majority of patients, though other measures of post-operative stability including central corneal thickness, effective lens position and visual acuity can require up to 4 weeks to stabilize. Thus a conservative and pragmatic approach may be to wait until 4 weeks post-operatively prior to obtaining refractive correction following uncomplicated phacoemulsification cataract surgery.

Dataset Information

Outcomes of Refractive Surgery Consultations at an Academic Center: Characteristics Associated with Proceeding (or Not Proceeding) with Surgery.

Publications

Outcomes of Refractive Surgery Consultations at an Academic Center: Characteristics Associated with Proceeding (or Not Proceeding) with Surgery.

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